联合使用跟骨內移截骨、外侧柱延长的手术技术是治疗 IIB 期平足症的常用方法。如何避免前足外展畸形过度矫正，最终实现个体化治疗和优化治疗效果。本文就此问题展开研究，供大家参考！
Abstract
•In the mid-1990s, a flatfoot reconstruction was proposed that combined the use of a medializing calcaneal osteotomy (MCO), a lateral column lengthening (LCL), and soft-tissue procedures for the treatment of stage IIB AAFD. More recent literature has suggested guidelines for the amount of correction necessary for each of these procedures based on individual deformity.
从 90 年代起，有作者提出联合使用跟骨內移截骨、外侧柱延长以及软组织手术技术治疗 IIB 期平足症。近年来，越来越多的文献提出了有效矫正某种特定畸形所需的矫形标准。
•In this paper, we describe our technique for flatfoot reconstruction for stage IIB AAFD, which includes a MCO, LCL, and flexor digitorum longus (FDL) transfer. Importantly, we discuss our preferred method of preoperatively planning the amount of medial translation for the MCO as well as the maximum amount of LCL to prevent overcorrection of the abduction deformity. This allows us to tailor the reconstruction and optimize our results.
本文中，作者介绍了其治疗 IIB 期平足的手术方法。更重要的是讨论了术前确定跟骨內移截骨的移位程度和外侧柱延长中避免前足外展畸形过度矫正最大程度的方法，最终实现个体化治疗和优化治疗效果。
Studies looking at outcomes following flatfoot reconstructions for stage IIB AAFD demonstrate excellent short-term and long-term results. We conclude by discussing complications of the operation, postoperative management, and the future of the technique.
Level of Evidence: Diagnostic Level V.
同时作者也讨论了治疗 IIB 期平足中短期和长期的并发症情况
Background introduction
•The definition of Stage IIB Flatfoot
talar head uncoverage > 30%
•MCO 跟骨內移截骨
Koutsgiann, medial displacement 1/3-1/2
•LCL 外侧柱延长
Evans, lateral column elongation by osteotomy and bone graft
•MCO
medial load reducing medialization of heel cord insertion the amount of displacement is obscure(10 mm?- supported by cadaveric study)
跟骨內移截骨可以降低内侧纵弓的应力，內移跟腱止点，但理想的內移程度尚未确定。仅有的尸体生物力学实验建议內移 10 mm.
•LCL
forefoot abduction reduction hindfoot valgus correction (up to 60%)
外侧柱延长手术可以矫正前足的外展畸形，同时可以矫正约 60% 的后足外翻畸形
参考文献 ：
•LCL overcorrection will lead to
lateral column rigidity stress fracture of 5th metatarsal
但外侧柱延长过度可能导致足外侧纵弓的僵硬，第 5 跖骨应力过度集中后的病理性骨折。
•What is the optimal correction that guarantee a satisfactory result?
如何通过恰当的畸形矫正来保证满意的治疗效果呢？
